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Mehmet Aslan 1 , Murat Tuncel 1 , Ebru Yalçın 2 , Berna Oğuz 3 , Mehmet Köse 2 ,

ASSESSMENT OF RELATION BETWEEN RESPIRATORY FUNCTION TESTS, VENTILATION/PERFUSION SCINTIGRAPHY AND HIGH RESOLUTION COMPUTED TOMOGRAPHY FINDINGS IN PATIENTS WITH CYSTIC FIBROSIS. Mehmet Aslan 1 , Murat Tuncel 1 , Ebru Yalçın 2 , Berna Oğuz 3 , Mehmet Köse 2 ,

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Mehmet Aslan 1 , Murat Tuncel 1 , Ebru Yalçın 2 , Berna Oğuz 3 , Mehmet Köse 2 ,

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  1. ASSESSMENT OF RELATION BETWEEN RESPIRATORY FUNCTION TESTS, VENTILATION/PERFUSION SCINTIGRAPHY AND HIGH RESOLUTION COMPUTED TOMOGRAPHY FINDINGS IN PATIENTS WITH CYSTIC FIBROSIS Mehmet Aslan1, Murat Tuncel1, Ebru Yalçın2, Berna Oğuz3, Mehmet Köse2, Deniz Doğru2, Mithat Haliloğlu3, Nural Kiper2, Uğur Özçelik2, Pınar Kıratlı1 Hacettepe University Faculty of Medicine, Ankara, 2008 Nuclear Medicine Department1 Pediatric Chest Diseases Department2 Radiology Deptartment3

  2. INTRODUCTION CYSTIC FIBROSIS : • CF was previously known as “a pediatric disease that ens with death in first year of life”. • Today we still dont have cure for the disease. • Knowledge about CF accumulating  comparably great improvement in survival and quality of life • Chronic lung involvement • Management: Symptom-sign control and preventive-prophylactic treatments.

  3. INTRODUCTION Lung involvement in CF: • A large portion of morbidity and mortality. • Characterized with mucus plugs, infection and inflammation cycles. • Most widely used standard study in clinical follow-up is respiratory function test. • FEV1 • %FEF 25-75

  4. PURPOSE To compare the findings of • Pletismography – Respiratory function tests (pRFT), • Ventilation-perfusion scintigraphy (VPS) and • Thoracal high resolution computed tomography (tHRCT) İn pediatric patients with CF.

  5. METHODS • A prospective study • Hacettepe University ethical commitee • İnforming and approval of patient and parents • CF patients selection criteria • Age 6-16 • Clinically mild-moderate lung disease • No active respiratory infection • pRFT, VPS and low dose tHRCT was done in same visit to clinics.

  6. METHODS • RFT-Pletismography • Physical examination at Pediatric Chest Diseases Dept. policlinics • Pediatric Chest Diseases Dept. Respiratory laboratory unit. • Quantitative values of parameters FEV1, %FEF25-75, VC, TLC, RV/TLC ve Raw

  7. METHODS • Ventilation and Perfusion Scintigraphy: • Tc99m-MAA used for perfusion scintigraphy, ultrasounically nebulized aerosol Tc99m-DTPA used for ventilation scintigraphy. Radiation dose: V: 0.15 mSv, P: 0,5 mSv • Gamma kamera, imaging done for 6 standard planes (anterior, posterior, both lateral, her both posterolateral views) • Scoring:(0-162) (Donnelly et al, 1997) visual defect scoring system, for each segment • Defect intensity: 1= <%25, 2= %25-75, 3= >%75 • Segment area: 1= <%25, 2= %25-75, 3= >%75

  8. METHODS • Thoracal HRCT : • Lowered dose, without contrast • Additional expirium slides • Radiation dose: 0.5-1.1 mSv • Scoring : (0-102) (Donnelly et al, 1997) • For each lobe, degree of: • Bronchiektasis (B) • Peribronchial thickening (PK) • Mucus plug (MT) • Air trapment (HH) • Bul (Bul) ve • Atelectasis/consolidation (A/K)

  9. METHODS • tHRCT scoring (Donnelly et al, 1997)

  10. FINDINGS • n = 17 • Age mean: 12 (st.dev.=2.3) • Age : min8–max16 • Female :5, Male: 12 • 1 patient couldn’t mange to do diffusion test, 1 patient’s tHRCT scoring couldn’t be done because expirium slices couldn’t be taken.

  11. FINDINGS • Normal perfusion scintigraphy score in 8, normal ventilation scintigraphy score in 6 patients. • 9 patients had abnormal ventilation and perfusion scintigraphy scores. • Statistically no difference between ventilation scintigraphy scores and perfusion scintigraphy scores (Mann Whitney U p: 0,980).

  12. FINDINGS “VPS and tHRCT” • A good correlation is detected between ventilation and perfusion scores and tHRCT scores (Table: Spearman correlation coefficient) • VS and PS scores have high correlation. (Spearman kk: 0.912**) ** correlation significant at 0.01 value (2-tailed) * correlation significant at 0.05 value (2-tailed)

  13. FINDINGS ”VPS and tHRCT”

  14. FINDINGS “PLETISMOGRAPHY – RESPIRATORY FUNCTION TESTS” • positive relation btw FEV1 and TLC, %FEF25-75,VC (Spearman correlation coefficient; 0.604, 0.587 ve 0.833) • negative relation between FEV1 and Raw, RV/TLC (Spearman correlation coefficient; -0.720 ve -0.436)

  15. FINDINGS ”pRFT and Imaging” • Among RFT parameters only RV/TLC showed significant relationship with VPS and tHRCT scores. ** correlation significant at 0.01 value (2-tailed) * correlation significant at 0.05 value (2-tailed)

  16. FINDINGS ”pRFT and Imaging”

  17. FINDINGS • FEV1, Raw and %FEF25-75 showed no significant relarionship with imaging scores (VPS ve HRCT)  

  18. Patient No 6 14y, M Perf Scint Score : 0 Vent Scint Score : 0 Tor HRCT Score : 3 Plet-RFT FEV1 (%N) : 93 %FEF25-75 (%N) : 120 VC (%N) : 99 TLC (%N) : 90 RV/TLC (%) : 14 Raw (%N) : 182

  19. Patient No 12 11y, M Perf Scint Score : 72 Vent Scint Score : 72 Tor HRCT Score : 51 Plet-RFT FEV1 (%N) : 47 %FEF25-75 (%N) : 54 VC (%N) : 50 TLC (%N) : 100 RV/TLC (%) : 61 Raw (%N) : 206

  20. Patient No 2 16y, F Perf Scint Score : 35 Vent Scint Score : 35 Tor HRCT Score : 28 Plet-RFT FEV1 (%N) : 106 %FEF25-75 (%N) : 84 VC (%N) : 124 TLC (%N) : 131 RV/TLC (%) : 27 Raw (%N) : 181

  21. Patient No 5 14y, M Perf Scint Score : 0 Vent Scint Score : 0 (defect score:0 but heterogenous aerosol deposition was reported) Tor HRCT score : 14 Plet-RFT FEV1 (%N) : 78 %FEF25-75 (%N) : 53 VC (%N) : 99 TLC (%N) : 102 RV/TLC (%) : 24 Raw (%N) : 204

  22. DISCUSSION • Findings of VS, PS and HRCT are found correlative between both three modalities.  • The high correlation shows that each of three modalities can be used alternatively for similar purposes. This is also can be said for choosing between scintigraphy and HRCT.

  23. DISCUSSION • Imaging scores showed correlation with RFT parameters but only RV/TLC showed statistically significance.  • Normal imaging Clinically and RFT abnormal patients ! • Significant pathological imaging findings Close to normal RFT’s and clinically silent patients ! • These findings are pointing that using only physical examination and RFT’s for assessing severity of the lung involvement (to modulate treatment and follow up) in the management of patients with CF can not be enough.

  24. CONCLUSION • Findings that suggest adding one of the three imaging modalities (which has high correlation in scores with each other) to routine can positively support follow-up of patients with CF. • It is hoped to reach to more accurate and true knowledge with increase in the number of patients for this study. ***

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